内侧柱是否使用螺钉支撑对锁定钢板治疗肱骨近端骨折的疗效比较

Comparison of clinical effect on locking plate for proximal humeral fracture with or without application of inferomedial screw

目的 ：比较内侧柱是否使用螺钉支撑对锁定钢板治疗肱骨近端骨折的疗效。方法 ：自2012年1月至2013年7月,采用锁定钢板治疗46例肱骨近端骨折患者,男25例,女21例;年龄29~80岁,平均55.1岁。其中内侧柱使用螺钉支撑组（支撑组）25例,男13例,女12例;年龄38~80岁,平均（55.8±11.8）岁;骨折按Neer分型：2部分骨折8例,3部分骨折10例,4部分骨折7例。内侧柱未使用螺钉支撑组（未支撑组）21例,男12例,女9例;年龄29~79岁,平均（54.2±14.8）岁;Neer分型：2部分骨折6例,3部分骨折9例,4部分骨折6例。比较两组患者的手术时间、骨折愈合时间及并发症情况,并在末次随访时采用Neer肩关节功能评分进行疗效评价。结果：46例患者获得随访,时间12~41个月,平均15.6个月。支撑组手术时间（1.6±0.4）h,未支撑组（1.5±0.4）h;支撑组骨折愈合时间（3.0±0.6）个月,未支撑组（3.1±0.6）个月;两组患者手术时间、骨折愈合时间比较差异无统计学意义（P〉0.05）。Neer肩关节功能评分支撑组（89.7±4.9）优于未支撑组（83.1±7.1）,差异有统计学意义（P〈0.05）。支撑组未出现明显并发症,未支撑组4例出现并发症。结论：内侧柱使用螺钉支撑对锁定钢板治疗肱骨近端骨折有固定牢靠、并发症少等优点,术后功能恢复更满意。

Objective： To compare clinical outcomes of locking plate for proximal humeral fracture whether application of inferomedial screws. Methods：From January 2012 to July 2013,46 patients with proximal humeral fracture underwent locking plates were retrospectively analyzed. There were 25 males and 21 females aged from 29 to 80 years old with an average of 55.1 years old. Among them, 25 patients were treated with inferomedial screws （support group）, including 13 males and 12 females aged from 38 to 80 years old with an average of （55.8±11.8） years old;8 cases were part two fracture, 10 cases were part three fracture and 7 cases were part four fracture according to Neer classification. Twenty-one patients were treated without inferomedial screws （non-support group） ,including 12 males and 9 females aged from 29 to 79 years old with an average of （54.2± 14.8）years old; 6 cases were part two fracture, 9 cases were part three fracture and 6 cases were part four fracture according to Neer classification. Operative time,fracture healing time and complications were observed and compared,Neer scoring of shoulder joint were used to evaluate clinical effect. Results：All patients were followed up from 12 to 41 months with an average of 15.6 months. Operative time and fracture healing time in support group was （1.6±0.4） h and （3.0± 0.6） months,and （1.5± 0.4） h and （3.1±0.6） months in non-support group,while there was no statistical difference in operative time and fracture healing time between two groups. There was significant differences in Neer score between support group （89.7±4.9） and nonsupport group （83.1±7.1）. No complication occurred in support group,while 4 cases occurred complications in non-support group. Conclusion： Locking plate with inferomedial screws for proximal humeral fracture has advantages of stable fixation,less complications, quick recovery of function and satisfied clinical effect. KEYWORDS Humeral fractures,proximal; Fracture fixation; Treatment outcomes